Related Experiment Video
Updated: Mar 5, 2026
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Quantifying the Mortality Impact of Do-Not-Resuscitate Orders in the ICU
Lior Fuchs1, Matthew Anstey, Mengling Feng
11Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 2Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. 3Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia. 4The Harvard-MIT Division of Health Sciences & Technology, Massachusetts Institute of Technology, Cambridge, MA. 5Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore. 6Center for Quality and the Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL. 7Department of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Objectives:
We quantified the 28-day mortality effect of preexisting do-not-resuscitate orders in ICUs.
Design:
Longitudinal, retrospective study of patients admitted to five ICUs at a tertiary university medical center (Beth Israel Deaconess Medical Center, BIDMC, Boston, MA) between 2001 and 2008.
Intervention:
None.
Patients:
Two cohorts were defined: patients with do not resuscitate advance directives on day 1 of ICU admission and a control group comprising patients with no limitations of level of care on ICU day 1 (full code).
Measurements And Main Results:
The primary outcome was mortality at 28 days after ICU admission. Of 19,007 ICU patients, 1,239 patients (6.5%) had a do-not-resuscitate order on the first day of ICU admission and survived 48 hours in the ICU. We matched those do-not-resuscitate patients with 2,402 patients with full-code status. Twenty-eight day and 1-year mortality were both significantly higher in the do-not-resuscitate group (33.9% vs 18.4% and 60.7% vs 40.2%; p < 0.001, respectively).
Conclusion:
Do-not-resuscitate status is an independent risk factor for ICU mortality. This may reflect severity of illness not captured by other clinical factors, but the perceptions of the treating team related to do-not-resuscitate status could also be causally responsible for increased mortality in patients with do-not-resuscitate status.
Related Concept Videos
01:27Ethical Issues
Ethical Concerns in Healthcare:
01:21Cardiopulmonary Resuscitation I: Adult
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:26Pneumothorax-I
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.
01:23Acute Respiratory Failure-IV
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...